On Monday, a man stepped in the Erika St syringe exchange station, in Kopli, Tallinn – announcing he saved his fourth person dying from fentanyl overdose. Not a record-breaker, though.

«There’s this other guy, he has thus resuscitated five,» says infection physician Nikolai Jaroslavtsev who teaches drug addicts and those close to them about resuscitation. He is talking about the project started last fall at the initiative of National Institute for Health Development (TAI), whereby a medicine named naloxone, in a yellow plastic box, is provided for addicts overdosing on the synthetic heroin aka fentanyl – to quickly bring them back to life.

«I know people have the attitude that why resuscitate the drug addicts... but I go by humaneness and I say a big thank you to the institute for this project,» says the physician. «Every day, I see the results with my own eye.»

Statistics flat

At Tallinn emergency medical care, in constant touch with overdoses, there is no such optimism. «Our usual statistics are three-four overdoses a day, as usual,» says chief doctor Raul Adlas. «So, for us, the project has changed nothing and for the taxpayer, talking about emergency medical care, nothing has changed.»

Naloxone is nothing new. For years, emergency medical staff has used it to resuscitate drug addicts. TAI just happened to decide, last fall, to distribute the medicine to drug addicts or people close to them – to make things easier for emergency staff and to save lives. The condition being that people pass a short course on use of the antidote and know that after it has been administered, the ambulance must still be called.

Nine months after the launch of «yellow box» distribution in Tallinn and Ida-Viru County, the numbers are as follows – naloxone use training has been passed by 546 people. Of these, 469 are injecting drug addicts.

Many of them are people on methadone treatment, undergoing the weaning process, desiring to help drug addicts among close family circles, friends or relatives. Mr Jaroslavtsev, having instructed about 220 people in Tallinn alone, says they included several mothers, and married couples.

But there also are the active injectors who know well how dangerous heroin may be even when slightly overdosed. «Main thing that the word would spread, about naloxone,» says Dr Jaroslavtsev. «So the people would know – a syringe in the yellow box found with a person lying unconscious may save the person’s life.»

According to the doctor, he is at long last seeing signs that the word is on the move, about the live-saving «yellow box». He proceeds to tell the story of a young man calling on the phone. In a gravel-pit close to Tallinn, the young man had witnessed a friend going on overdose. «He recognised the yellow box and, being instructed over the phone, he was able to help the person.»

If the overdosed person is still breathing, injecting naloxone is simple, on the face of it – the syringe is prefilled, it just needs the needle attached and the person turned into the right body position. The injection must go into a muscle and may be done straight thru clothes. The wake-up from under the drug is fast but unpleasant. Therefore, quite often, the people saved get angry at their saviours.

All in all, within the programme, naloxone has already been handed to 544 people. That’s only twice less than those trained. And a repeat dose of naloxone has been handed out on 72 occasions. In at least 63 cases of these, the person getting their new yellow box claimed to have used the initial one to resuscitate someone. Some people, however, have lost the medicine.

The first half year drug deaths statistics are encouraging. Year-on-year, 20 less died of overdose, the toll dropping from 74 to 54. True: not too often has North Tallinn Prefecture’s drug police detected the «yellow box» with arrested addicts – for the six months, they only recall three such cases.

So what will be cheaper?

But the project is far from failed. Most importantly – lives are saved. As also underlined by the emergency medicine chief doctor Raul Adlas. And when cynically counting up the money, even here the sceptics get a backlash.

As rhetorically asked by TAI drug prevention head Aljona Kurbatova: will the autopsy and the burial be cheaper on the taxpayer than the two dozen euro injection?

«We see this as a permanent service,» promises Ms Kurbatova. «Ehen a drug addict gets an overdose, in 60 percent of the cases there is someone close by who could save his live with the yellow box. True, the box will not substitute for ambulance as the overdose may last for eight hours. But it helps to prevent the worst.»

Naloxone

• Used since the 1960ies.

• To fight drug abuse, used in the USA since 1990ies.

• In Europe, initial use was in Scotland, in 2006; by now, it is used in Italy, Denmark, Spain and the UK.

• Estonian and Scotland are the only countries where naloxone use is financed by the state. Both countries have European topmost drug death counts.